HIgh frequency hearing loss from low frequency noise

It has long been believed that the spectrum of hearing loss closely matches that of the presenting noise. An antiquated study by Mill et al showed that this is not always true.

Human subjects were exposed to an octave-band noise for 24 hours. Temporary threshold shifts increased for the first eight hours of exposure and then were asymptotic. While threshold shifts were largest at about one-half octave above the center frequency of the noise, a second maximum was observed at higher test frequencies. The exact frequency of this second maximum decreased from 7.0 kHz, for a noise centered at 2.0 kHz, to 5.5 kHz for a noise centered at 0.5 kHz. This result could be caused by the travelling wave pattern along the cochlear partition or to the production of distortion products.

PubMed

Effects of gastroesophageal reflux disease in laryngeal carcinoma

GERD as a contributory factor to laryngeal carcinoma is much appreciated in the ORL community, but just how strong is it as a risk? Should it be aggresively investigated and treated if the risk is high?

An Italian retrospective investigates the association with 36 consecutive non-smoking and non-drinking patients with histologically confirmed SCC of the larynx vs a control, a group of 125 lifetime non-smoking and non-drinking cancer-free subjects. Patients with laryngeal cancer had a higher prevalence of gastroesophageal reflux disease than the control subjects (P < 0.0001).

PubMed

New centre for deafness research

'A new centre is to open in London in the new year, bringing together the previously disparate fields of research into deafness and communication.

The Deafness, Cognition and Language Research Centre (DCAL) will be based at University College London and will be funded by a 4.5m grant from the Economic and Social Research Council (ESRC), it was announced yesterday.

The aim of the centre is to create "a world-class hub of excellence" that will connect research into neuroscience and linguistics to issues affecting deaf individuals in their communities. It will also seek to challenge the perceptions of deafness and study sign language and communication techniques. All the centre's researchers will be expected to become fluent in British Sign Language.'

EducationGuardian.co.uk

Medical management of middle ear disease in children less than 2 years of age with sensorineural hearing loss

'Pneumatic otoscopy should be used to diagnose middle ear effusion. Clearance of OME may be prolonged in children with craniofacial abnormalities. Antibiotics provide a small short-term increase in the resolution of OME and may be warranted in children with coexisting SNHL and OME for 4 to 6 weeks. If OME persists for 8 to 12 weeks, bilateral myringotomy and tube placement (BM&T) with short-term tubes will improve hearing and help resolve OME. AOM in children less than 2 years of age should be treated with a 10-day course of antibiotics. Prophylactic antibiotics may be useful in avoiding tube placement in children less than 2 years of age with recurrent AOM. BM&T with short-term tubes are recommended if recurrent AOM persists. Pneumococcal vaccination can decrease episodes of AOM by 6 to 7%.'

Above are the recommendations based on a meta-analytic study by Westerberg BD, et al. in J Otolaryngol. 2005 Aug;34 Suppl 2:S64-9.

Wherefrom the infection?

A 55yr-old man had craniectomy and drainage for a huge intracranial temporal lobe abscess and an ipsilateral extracranial temporal abscess as seen in this CT scan. He was referred to ENT for clearance of a possible foci of infection from the mastoid or middle ear which would seem to be the case from the 2nd image presented here. A large area of erosion is seen in the mastoid, communicating with the middle fossa as well as the temporal space.







The history, however, was not quite so convincing. He had no history of chronic ear discharge, and was not diabetic. The only lead was one experience of external ear infection 3 months ago after he traumatised his ear canal by overenthusiastic cleaning. Examination would show an external canal filled with pus, a sagging posterosuperior meatal wall, a soft and fluctuant postauricular region and a discharging sinus.



























I proceeded to perform a mastoid exploration/cortical mastoidectomy but to my surprise found only a sclerotic mastoid and no foci of disease at all. Drilling was carried all the way down to the bony defect where dura is clearly seen. No pus, granulation, or cholesteatomas found.

So where was the foci of infection? How did an abscess of such magnitude, with such extensive destruction of bone come about? We are hoping a HRCT will give us more clues. Could this be a skull base osteomyelitis secondary to otitis externa?

Genetic Differences Determine Taste Perception

By Daniel DeNoon
WebMD Medical News
Scientists looked at a specific taste receptor for a bitter substance known as PTC. Small changes in the genes made big differences in the receptor's ability to recognize the bitter chemical. This helps explain why some people can't taste PTC at all while others find it terribly bitter - and still others find it bitter in varying degrees.
Read the full article

Interview: Genes and Deafness

Host Jennifer Ludden discusses the new research breakthrough on hearing loss with Dr. James Battey, who directs the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health. Dr. Battey explains what research remains to be done, before gene therapy can be tested on humans.

Listen to the interview by Jennifer Ludden

Gene Therapy for Deafness

By Roger Highfield
American scientists have found that the transplant of a specific gene permits the growth of new hair cells in the inner ear.. The technique, which one day could help millions of people worldwide, was described yesterday by Dr Yehoash Raphael of the Kresge Hearing Research Institute, University of Michigan, in the journal Nature Medicine.
Read the FULL ARTICLE

Cure for sensorineural deafness?

Researchers in the US have for the first time restored hearing in deaf mammals - a feat that represents a major step toward treating people with acquired hearing loss.

By inserting a corrective gene with a virus, the team at the University of Michigan Medical School induced the formation of cochlear hair cells - the key intermediaries in converting sound waves into electrical impulses - in the ears of artificially deafened adult guinea pigs, according to the Los Angeles Times.

Read the FULL ARTICLE

Just when you taught it was safe!

from REDNOVA
'The prevalence of asthma has increased worldwide. The reasons for this rise remain unclear. Various studies have reported an association between acetaminophen, a widely used analgesic, and diagnosed asthma. In a prospective cohort study, the rate of newly diagnosed asthma was 63% higher among frequent acetaminophen users than nonusers in multivariate analyses. Studies of patients with asthma suggest that acetaminophen challenge can precipitate a decline in FEV^sub 1^ > 15% among sensitive individuals. Plausible mechanisms to explain this association include depletion of pulmonary glutathione and oxidative stress. This article reviews the existing literature and evaluates the epidemiologic and pathophysiologic evidence underlying a possible link between acetaminophen and asthma. (CHEST 2005; 127:604-612)'

-- An excellent article reviewing the association between acetaminophen and atopic diseases. Could it also be related to allergic rhinitis? Just when you taught some drugs were safe... Ed.

read the FULL ARTICLE

Men 20-29 most at risk for sleep apnea

by GLOBES Correspondent
'According to a new study, men in their 20s are most at risk for sleep apnea, and need to be screened the most. The study, carried out by the Technion-Israel Institute of Technology, showed that men aged 20 to 29 with severe sleep apnea have 10 times the risk of dying from heart related ailments than their non-sleep apnea peers in the general population, and a much higher risk than older men with sleep apnea.

The Technion study, which appears in the March 2005 European Respiratory Journal, was based on the largest population of sleep apnea patients (nearly 15,000 men) ever to be studied. All were recorded in the Technion sleep clinics in Israel from 1991 through 2000. The researchers compared the risk of dying for men with severe sleep apnea -- having at least 50 breathing stops per hour -- with the general population.'
read the FULL ARTICLE

An aberration in a natural pattern

by Joan Skelton
'With so many other grieving parents, I weep at this variance. I am 25 years older than he is. I should be dying, not him.

He had actively been in the medical system for three months with golf-ball size lymph nodes, head, face and neck pain, blocked ears, difficulty swallowing, weight loss and fatigue. His treatment was a stent in his ear, then the recommendation of two weeks of bed rest because of "exhaustion" and "viruses," finally antibiotics for "sinusitis" and Percocet. Percocet! Then, a CT scan showed the possibility of a tumour.

At least four health professionals made grievous mistakes in the care of my son. Were they irresponsible? Negligent? Incompetent? Unlikely. Undoubtedly, they are over-worked, tired, stressed out, scratching to maintain a semblance of sanity in a system that would suck out their soul, if they let it. Such is our Canadian health-care system.'

- A grim but not uncommon story to remind us of the 'failures' of the health care system. If only to keep us alert. YY

read the FULL ARTICLE

Brain gene for Presbycusis

from Health India
A new study conducted by researchers at University of Rochester Medical Center suggests that a "feedback" problem in the brain diminishes our ability to hear.
"Traditionally, scientists studying hearing problems started looking at the ear. But we are finding patients with normal ears who still have trouble understanding a conversation. There are many people who have good inner ears who just don't hear well. That's because their brains are aging." lead researcher, Robert D. Frisina was quoted as saying.
Read the FULL ARTICLE

Saliva Testing for Head and Neck Cancer?

by Robert Preidt
'New discoveries in proteomics -- the study of proteins found in saliva and elsewhere throughout the body -- is bringing saliva testing within spitting distance of other much-used screens, such as blood or urine testing, the experts said.
Saliva and other oral fluids contain many of the same proteins and other molecules found in blood and urine that can reveal the presence of diseases, including head and neck cancers, the researchers noted.'
Read the FULL ARICLE at Forbes Health

Lives together, beds apart

by PAULA GANZI LICATA, Newsday.com
'While many older couples remain young valentines at heart, experts say, the increase of snoring, sleep disorders and stirring in bed often spurs partners to consider separate bedrooms. Hertz recommends separate beds or bedrooms for some patients, but stresses taking gradual steps to determine a solution. If the sleep disorder is just movement, as in restless leg syndrome, separate beds in the same room will work, she said. But if the disorder is a noise issue such as snoring, separate rooms may be needed.'
read FULL ARTICLE

Gene Profiling May Improve Treatment of Head and Neck Cancer

NEW YORK JAN 10, 2005 (Reuters Health)
'The gene expression profile of metastatic head and neck cancer is distinct from that seen with forms that have not spread, a finding that could improve the treatment of this malignancy, Dutch researchers report.

For certain cancers, such as head and neck squamous carcinomas (HNSCCs), early detection of metastases to nearby lymph nodes is critical for appropriate therapy, senior author Dr. Frank C P. Holstege, from University Medical Center Utrecht, and colleagues note. Unfortunately, these metastases are often difficult to detect, resulting in inappropriate treatment for many individuals.

In the present study, reported in the February issue of Nature Genetics, Dr. Holstege's team describes the identification of gene expression profiles that correlate with HNSCC lymph node metastases.'

AAAAI Urges Seasonal Allergy Sufferers to Consider Immunotherapy

from An AAAAI News Release
'For seasonal allergy sufferers, the cold winter weather brings much needed relief from watery eyes and runny noses. But with the peak allergy season around the corner, few allergy sufferers find time to relax. Rather than dreading the months ahead, a technique called immunotherapy, or allergy shots, may rid their suffering once and for all.'

Insect Ears?

Many leave their hearing aids at home, by Mary Duenwald, NEW YORK TIMES

'In the pipeline are hearing aids that mimic the hearing apparatus of a kind of parasitic fly, Ormia ochracea, which has a keen sense of where sounds come from.

This insect's ears are connected by a platelike structure that senses both vibrations and pressure in such a way as to act like a tiny directional microphone, said Lynn Luethke, an audiologist and neurologist at the National Institute on Deafness and Other Communication Disorders in Bethesda, Md.

Hearing aids patterned after the fly's ear are expected to be ready in the next three to six years, Luethke said.'

Through with Chew Week

Herald-Dispatch.Com
'In an effort to call attention to the dangers of using smokeless tobacco, The Appalachian Family and Children First Council has proclaimed the week of February 13-19 as "Through with Chew Week."

The public awareness campaign is designed to reduce the use of smokeless tobacco, especially among young people, said Maxine Lewis, community tobacco prevention specialist for the Lawrence County, Ohio, Health Department. According to the Centers for Disease Control, 6.6 percent of senior high school students use smokeless tobacco.'

Adverse Effects of Fluoride

New York (ArriveNet - Feb 10, 2005) “The combination of gastric problems, difficulty in swallowing, leg muscle pain, and pain in the knee and hip joints is a key indicator of fluoride toxicity, and patients using high-concentration home fluoride treatments should be monitored for these symptoms,” is reported in the January 2005 Journal of the American Dental Association.

Laryngopharyngeal reflux reviewed

'Over the last 3 decades, many reports have implicated refluxed gastric acid as a cause of, or as a contributory factor in, development of chronic laryngeal and pharyngeal disorders. Although this putative cause-effect relationship has been strengthened by more recent evidence, the body of evidence on causation, diagnosis, and treatment of these increasingly diagnosed disorders is still evolving. A variety of symptoms, functional and structural abnormalities involving the larynx, and other contiguous structures positioned proximal to the esophagus constitute the spectrum of these disorders (see the list below). Various terms such as supraesophageal gastroesophageal reflux disease (GERD), atypical GERD, laryngopharyngeal reflux (LPR), and extraesophageal complications of GERD have been used to describe this group of symptoms and signs.'
- Jeegar Jailwala and Reza Shaker reviews the theory and literature regarding laryngopharyngeal reflux at emedicine.com.

Dystonia and Botox injections

The first thing you notice about "Joey" is that his head is turned and tipped to one side; his left ear rests on his hunched-up left shoulder. He has to turn his whole upper body to look at you. Joey has torticollis, also known as cervical dystonia, meaning that his neck muscles are in an involuntary spasm that forces his head into its painful, abnormal position. - Mary Kugler from About.com writes about the diagnosis and treatment of facial and cervical dystonia.

How I straightened out my dizzy BPPV world

from The Republican
In writing this column, I run the risk of being charged with practicing medicine without a license. But if what I have to share helps just one person, I'm willing to take the chance. I'm going to write about BPPV, the acronym for benign paroxysmal positional vertigo. It's a dizziness that is caused by infinitesimal granules of debris that have the formal name of "otoconia," and are crystals of calcium carbonate, which come from a spot in one's ear called the utricle.

Top 10 reasons for sore throat

Throats are Easy Targets for Irritation
There are many causes of irritating, scratchy and painful sore throats, making it difficult at times to swallow, eat and talk. According to Lisa Chavis, R.Ph., pharmacist consultant to Cepacol® sore throat products, "Viruses and bacterial infections are frequently to blame, but are not always the culprit." Here is a breakdown of the top 10 reasons throats get sore:

Rhinitis news

FDA MedWatch: ZyPREXA (olanzapine) and ZYRTEC (cetirizine HCI)
PharmaLive.com (press release) - Newtown,PA,USA. Eli Lilly and Company has received reports of medication dispensing or prescribing errors between our atypical antipsychotic ZyPREXA (olanzapine) and the antihistamine ZYRTEC (cetirizine HCI) marketed by Pfizer. These reports include instances where Zyprexa was incorrectly dispensed for Zyrtec and vice versa, leading to various adverse events in some instances. These errors could result in unnecessary adverse events or potential relapse in patients suffering from schizophrenia or bipolar disorder.

MOLD Allergies
allergies.about.com - USA
Molds may be a major contributor to seasonal and perennial allergic rhinitis, as well as other health problems. Although thousands of molds exist, only a few dozen different types are significant allergens. Mold spores can easily become airborne and can be found almost anywhere. Because they are so small, mold spores may invade the protective mechanisms of the nose and upper respiratory tract.

Antibiotics don't seem to increase bacterial resistance

from USNews.com
Doctors are often reluctant to prescribe antibiotics for people with chronic sinus infections because bacteria can develop resistance to the antibiotics. Researchers in Boston looked for resistant bacteria in those patients.

What they found: Patients did not tend to have more resistant bacterial populations over time. If anything, their bacteria may have become less resistant to antibiotics.

Chronic Sinusitis Breakthrough

Two 1999 scientific breakthroughs may lead to long-term relief for allergy and chronic sinusitis sufferers.

The most startling announcement was published in the 1999 Mayo Clinic Proceedings. Researchers found that chronic sinusitis, a condition that affects about 37 million people in the United States, is apparently caused by an immune response to fungus.

Up until then the cause of chronic sinusitis was unknown, but it was suspected to be an allergic response. This research indicates that the condition is not caused by an allergic reaction, but by an immune reaction.

Full article at Allergies.About.Com

Anti-Fungus Drug Useful for Sinus Problem

NEW YORK (Reuters Health) - Treatment with a nasal spray containing the anti-fungal drug amphotericin B reduces the swelling and inflammation that occurs with chronic rhinosinusitis, a common cause of stuffy nose and facial pain, new research shows.

Amphotericin B is an old drug that can cause serious side effects, particularly to the kidneys. However, when given as a nasal spray, the drug does not get absorbed, effectively avoiding these effects, researchers report in the Journal of Allergy and Clinical Immunology.

Rhinosinusitis - Review of January 2005

by Y.Y.Yap, MD

Our understanding of rhinosinusitis and how we can best treat this ambiguous condition is in rapid evolution.

Fungal etiology for RSS
First off we have Gosepath J and Mann WJ. take a closer look at the role of fungi role in initiating and maintaining CRSS. While fungi are ubiquitously present in ALL, an immunologic sensitization in RSS patients is evidenced by specific cytokine production in blood-derived lymphocytes not found in controls. Sasama J, et.al also supports this theory showing from literature that eosinophilic inflammation in the nasal mucosa seems to be a specific reaction to certain molds in the nasal and paranasal cavities. Hence the shift from a bacteria-driven etiology to a fungal based one for RSS. It's implications for research and treatment is pressing and is reviewed in these articles. As though to dispel all doubt, Ponikau JU, et.al boldy instituted a clinical trial and showed that intranasal amphotericin B reduces inflammatory mucosal thickening on both CT scan and nasal endoscopy and decreases the levels of intranasal markers for eosinophilic inflammation in patients with CRS.

Recurrent Rhinosinusitis - something different?
Bhattacharyya N, Lee KH. try to distinguish Chronic Recurrent (CRRSS) from Chronic Persistent Rhinosinusitis (CPRSS) by looking at a distinct group of patients who have symptom free periods between at least 4 episodes of RSS symptoms a year. Interestingly the chronic recurrents (CRRSS) seem to suffer more, require more antibiotics and miss work more than the chronic persistents.

FESS for children?
Lieser JD, Derkay CS review the role of FESS in children. Present consensus for FESS in children are 'when maximal medical therapy, adenoidectomy, and culture-directed systemic antibiotics have all failed with persistence of sinonasal disease, when anatomic abnormalities predispose to chronic rhinosinusitis by obstructing normal sinonasal drainage pathways, in sinonasal polyposis to facilitate application of topical steroids', among others. The debate for the best timing for surgery and the fine balance between interfering with facial growth vs. quality of life continues.

No limits!
The greats have spoken! Cohen NA and Kennedy DW. have come forward to defend a larger role for the endoscopic surgeon, stating: 'Endoscopic sinus surgery is no longer exclusively for the management of chronic rhinosinusitis and nasal polyposis. Sinonasal malignancies, as well as anterior skull base lesions have become part of the rhinologist's responsibility. Furthermore, selective lesions managed through traditional craniotomies may now be accessed via trans-sinonasal transcranial endoscopic routes.' They attribute this increased scope, safety and efficacy to advancements in imaging technology including image acquisition, three-dimensional reconstruction, stereotactic navigation, and CT-MRI fusion.

Rapid steps forward are being made on the basic science, pharmacotherapeutics and surgical fronts in rhinology. The future is bright!

Link Between Cancer And Common Asian Nut

Study Confirms Link Between Cancer And Common Asian Nut - from NewsRx.com

November 4, 2004

Over the past couple of decades, scientists have been perplexed by a substantial rise in the incidence of head and neck cancers among Taiwanese men. According to cancer statistics, the disease increased by 85% among men there from 1981-2000.

A new study, presented at the American Association for Cancer Research Third Annual International Conference on Frontiers in Cancer Prevention Research, now suggests that the increased incidence may be linked to increased domestic production of a popular legal stimulant in Asia called betel quid.

Chewing betel quid, traditionally practiced in many parts of Asia and in Asian immigrants around the world, can be likened to tobacco use in the U.S. It is often rolled like a cigar or intricately folded and generally consists of a betel palm leaf spread with lime paste (calcium hydroxide) wrapped around a slice of areca nut. Betel quid is chewed for many reasons, including for its stimulant effects, to satisfy hunger, to sweeten the breath, and as a social or cultural practice.

However, betel quid also is considered a nuisance in Asia where the reddish juice, generated by the act of chewing betel quid, can be found all over the ground and on public buildings. Also considered a major public health risk, it is believed to be a leading cause of oral cancer in this part of the world.